Doctors at the University of Maryland Medical Center had a mystery on their hands. A 51 year old physician colleague who looked the picture of health no cardiovascular risks, a marathon runner who had exercised vigorously each day for 30 years had just flunked a calcium screening scan of his heart. The patient had expected a score indicating a healthy cardiovascular system. Instead, the images indicated a high score: a build up of calcium in his coronary arteries put him at high risk for blocked blood vessels and a possible heart attack. The mystery was all the more intriguing because his resting blood pressure and fasting cholesterol levels, the usual measures of cardiovascular health, were in the normal range. In the March 1, 2007, issue of the American Journal of Cardiology, the researchers say this is the first case, to their knowledge, of advanced coronary calcification in an otherwise healthy middle aged male marathon runner who lacked traditional cardiac risk factors and had no symptoms of heart disease. The researchers conclude that the physician's intense, long term exercise regime, coupled with a predisposition toward a type of hypertension, contributed to his cardiovascular disease. "But we also found that this individual has exercise induced hypertension, which I think is vastly under diagnosed." Oxidative stress is a byproduct of the normal cellular metabolism of oxygen. It refers to cell, tissue or organ damage from a class of molecules associated with oxygen metabolism, including unstable molecules called "free radicals." Oxidative stress plays a role in many heart, lung, blood and sleep disorders, including atherosclerosis, or hardening of the arteries, hypertension, heart failure, asthma and sleep apnea. To help gage the impact of oxidative stress on the patient's cardiovascular system, his doctors evaluated the response to exercise of the endothelium, the lining of his arteries. An ultrasound device was used to measure what is known as flow mediated vasodilation. It shows how well the endothelium responds to a sudden increase in the flow of blood through an artery in the upper arm. The endothelium in a healthy vessel typically dilates or expands during this test to accommodate the increased blood flow, while an impaired vessel constricts or narrows. The patient's blood vessel dilation was normal before exercising. But after exercise, vessel constriction occurred immediately and showed no improvement after an hour. To put this response into perspective, the researchers administered the same exercise/blood vessel response test to a group of ten men whose mean age was 41. The vessels of these men initially constricted, but improved significantly one hour after exercise. Several weeks later, the patient was given vitamins C and E just before exercise and was tested again for endothelial response. These vitamins are known as antioxidants and may protect cells from free radical damage. This time, the test revealed a partial reversal of the blood vessel constriction after one hour, and normalization after two hours. "As he took the vitamin C and vitamin E, you could see improvements in his brachial arteries," says Dr. Miller. "We recommended that the patient take these vitamins before he runs." With half the mystery solved, the research team explored another possible cause of the calcium buildup elevated blood pressure. Hypertension can cause artery walls to thicken and the endothelium to narrow. This narrowing can promote the formation of fatty plaque deposits in artery walls. The plaque, from cholesterol and fats, can eventually harden or calcify. Although hypertension did not seem to be a risk factor for this patient, exercise is a major factor in his life. So, the researchers turned to a treadmill stress test to measure his blood pressure during exercise. At the start of the treadmill test, his baseline blood pressure was normal, 118/78 millimeters of mercury (mmHg). He was in such great shape that it took 20 minutes to reach high blood pressure levels, and this happened only after the treadmill speed and incline had been raised. But by the end of the test, his blood pressure had soared to 230/78 mmHg. A check of several of his previous treadmill tests indicated a similar rise in blood pressure. On the basis of running duration and intensity, the researchers estimated that the patient spent about 30 minutes a day at a systolic blood pressure above 200 mmHg. This number is well into the blood pressure danger zone and meets one definition of exercise induced hypertension a jump of at least 60 mmHg from baseline after exercise. This finding should be investigated further, says co investigator Matthew R. "Because we know that blood pressure rises during a stress test, we tend not to pay attention to it. We're more interested in changes in electrical activity and the redistribution of blood during exercise, which could indicate inadequate blood supply to the heart muscle," says Dr. Weir. "The question is, should we pay more attention to treadmill induced changes in blood pressure as a means to identify people at risk for developing coronary artery disease?" Dr. Miller adds another question, "Should we screen all middle aged individuals who want to participate in an exercise program to make sure they don't have exercise induced high blood pressure?" Unlike cholesterol or triglyceride levels, blood pressure levels fluctuate dramatically throughout the day, depending on a variety of factors such as exercise, emotions and even the time of day. In light of that phenomenon, Dr. Weir says the study raises another issue. "This research indicates that we need a more dynamic measure of blood pressure to truly profile the risk of an individual. We've been using casual, at rest office readings of blood pressure for more than 50 years. It's not bad, but it's not the answer." The treadmill is one way to gather a more dynamic measurement, but he says there's an easier option. "It can even be done at home if you have a blood pressure cuff and someone who can take your blood pressure at peak exercise." The patient in the study continues to run, but is now taking medications to lower both his cholesterol and blood pressure. Despite his exercise regime, he appears to be in the same boat as millions of Americans who do not exercise regularly. So, is too much exercise a bad thing? The physicians answer to the contrary. "We are not publishing this report to suggest in any way that people should not be exercising. Exercise has stood the test of time as being one of the best ways to modify cardiovascular risk," says Dr. Miller. "But what we're looking at are improved detection methods for predicting those at risk. 308497 141 Air Jordan 4 Retro Military Blue White ,Air Jordan 11 Low White Black Red 136066 041 Air Jordan 1 Retro Black Blue 653996 146 Nike KD 7 USA 653996 840 Men Size Nike KD7 35K Degrees 2014 656503 010 Air Jordan Future Black Black White 378037 010 Air Jordan 11 Bred Black Varsity Red 646701 700 Kobe 9 EM 528896 101 Air Jordan 11 Low White Varsity Red Air Jordan 5 Light Graphite White Wolf Grey If you ask a married woman if there is any one thing she would have done differently at her wedding, she is highly likely to say the following statement: "I wouldn't have done anything differently, expect maybe to have worn more comfortable shoes". When planning a wedding outfit, style, beauty and originality tend to be the main concerns. However, by the end of a very long day, once the ceremony has taken place, once the speeches have been given and the dance is about to start, such high minded concerns may seem of far lesser importance if your feet are eye wateringly painful. The good news is that you don't always have to sacrifice style for comfort, you just have to think things through carefully and put aside some time to break your shoes in. Breaking shoes in can make the difference between complete enjoyment and happiness and contentment on your wedding day, and near complete happiness, marred only by a rather great discomfort. Well made shoes don't have to feel like they're made of razor blades. If they do, it may well be because they don't fit properly. One of the first and most obvious points to make is that you should spend a good amount of time with a professional shoe fitter who will talk you through all the potential pitfalls in shoe buying. One tip I can recommend, is to go to a very expensive shoe shop and ask to try on a few shoes. The people who work in these shops are hired to know what they are talking about. If they recommend a certain type of shoe that might be the best shape for your type of feet, take note of it. If you can't afford the shoes they are selling, you may well find a much cheaper version, that with a little bit of effort, will have come to you from an expensive expert. Another thing to bear in mind is the possibility of choosing shoes that are specifically designed to look both comfortable and graceful: dance shoes. Have you ever wondered how some ballroom dancers seem able to practically run and do handstands in their high heels? Well, did you know that these high heels can feel as soft and bendable as toffee? Dance shoes tend to have reasonably small heels, however. If you are thinking of wearing heels that are over two inches, you may have to opt for the "breaking in". The general consensus is that wearing the shoes indoors for an hour or two a day in the months running up to the wedding is the best way to wear them in without actually wearing them out. 308497 141 Air Jordan 4 Retro Military Blue White,NORMAL, Ill. (Purdue Sports) Consecutive big innings allowed Purdue baseball to open up an 8 0 lead and Patrick Kenney shut the door after Illinois State rallied to make it a two run game, closing out an 8 6 win for the Boilermakers Tuesday evening. Purdue became only the second visiting team to win at ISU's Duffy Bass Field this season. The road team has won seven consecutive games in the annual midweek series between the Boilers (12 29) and Redbirds (29 13). Kenney gave up a two run single to the first batter he faced but came back to retire five of the next six. The game ended on a line drive double play to third base, with Steve Maniago doubling off the runner at first base to erase a one out hit by pitch. Sean McHugh connected for a three run double to left center with the bases loaded in the sixth inning, extending Purdue's lead to 7 0. After working three innings of one hit ball in his first start on the mound since Feb. 23, Kyle Wood also delivered a two run single with the bases loaded to get the scoring started in the Boilers' four run fifth inning. He reached base safely for the 22nd consecutive game in which he has batted. Jeff Evak posted his first career three hit game, leading off the third, fifth and sixth innings with singles. Fellow freshman Matt Frawley (1 0) was awarded his first collegiate win after retiring the first eight batters he faced, stranding a pair of inherited runners in the bottom of the fifth by retiring ISU's 3 4 5 hitters in order. Kyle Upp and Brandon Krieg each had a pair of hits and an RBI. Cody Strong reached base safely four times and scored twice. Purdue won the game despite striking out a season high 15 times and stranding 13 runners on base. The Boilers' five pitchers that took the mound issued a combined 11 free passes (seven walks, four HBP). Kenney was the only Purdue pitcher that did not walk a batter. Illinois State stranded 12 runners, including the bases loaded in the third and fourth innings. The Redbirds had the tying run at first base with no outs in the eighth inning after a two run single from Paul DeJong with the bases loaded. The first five hitters of the frame had reached base safely despite DeJong recording the only hit. Cleanup hitter Mike Hollenbeck had connected for a two run double his last time up to get ISU on the board, but he was given the bunt sign in this at bat. After fouling away a pitch for strike two, the Redbirds gambled and kept the bunt play on. Hollenbeck fouled off another pitch to go down on strikes. Kenney struck out the next batter and got out of the inning on a ground ball to second base. Illinois State starter Will Headean (3 2) was ejected from the game in the fifth inning after a two out RBI single from Upp put the Boilers in front 4 0. The left hander had issued a pair of walks in the inning and five on the day, and felt he was being squeezed by the home plate umpire. Five of the six runners that scored for ISU over the seventh and eighth innings reached base via a walk, hit by pitch or an error. Brett Haan only retired one of the six batters he faced but that one out was a big one, ending the bottom of the seventh with runners on first and second base. Adam Dressler got out of a bases loaded jam without a run scoring in the fourth inning to keep the game scoreless. Evak's leadoff single along with walks to Strong and McHugh set the stage for Wood's two run single through the right side in the top of the fifth. McHugh went first to third on the hit and scored on Kyle Johnson's sacrifice fly to center field. Wood had already stolen second base when Upp came through with his second hit to right center in as many at bats, driving in a run this time. The extended rally marked only the second time this season Purdue had scored four runs in an inning. The 8 0 advantage entering the bottom of the seventh represented the Boilers' biggest lead of the season. Evak, Krieg and Strong were aboard when McHugh sent a pitch into the left center field gap to clear the bases. A leadoff single for Maniago and an RBI double from Krieg plated another insurance run in the top of the seventh. Krieg has now reached base safely in 10 straight games. The Boilermakers return to action Friday when they open a three game Big Ten series at No. 11 Indiana. It will be the first time the two rivals have met in the regular season since May 2011.
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